Study: Pedaling might power down Parkinson's

An observational study is intended to quantify what so far has been anecdotal evidence that twice-weekly cycling sessions at top speed can soften or delay many symptoms of the disease.

By BARBARA PETERS SMITHbarbara.peters-smith@heraldtribune.com

Inside a sweat-steamed cycling studio at the Frank G. Berlin branch of the Sarasota YMCA, members of a highly select class are pedaling their hearts out.

In the narrow, dimly lit room, the cyclers seem intent on a bright screen before them that looks like something from a TV game show, with colored squares that display their first names and their real-time heart rates. Each square is green, yellow or red — depending on how close that participant is to an individual, pre-set goal for sustained high-energy exercise.

When the session ends, the riders dismount, beaming with exhilaration from their efforts, softly chatting and laughing with each other. Some show the off-kilter posture or slightly fluttering hand that is a hallmark of the Parkinson's disease they have in common. Others may sway their hips from side to side as they speak about the class.

But all of them — at an average age of 71 and 12 weeks into their experimental cycling program — believe they are better off than when they started.

The 17 participants, from age 60 to 78, are local patients diagnosed with Parkinson's — an age-related progressive neurological disorder that limits movements, balance and the ability to have a normal life. They volunteered for a study conducted by the Neuro Challenge Foundation, a Sarasota non-profit, with a grant from the Roberta Leventhal Sudakoff Foundation. Once the research data are analyzed and published, Sarasota's fledgling "Pedaling with Parkinson's" class could become a model for offering hope to patients like them everywhere.

This observational study is intended to quantify what so far has been anecdotal evidence that twice-weekly cycling sessions at top speed can soften or delay many symptoms of the disease.

"Some of the benefits we have already seen are improved speech, improved gait and balance," says Jennifer Williams, a care advisor for Neuro Challenge who has tracked the volunteers through the 12-week study. "A lot of folks are coming in without their walkers and their canes. Now they are getting on and off the bikes by themselves, which is huge. And the camaraderie of the class has helped with a lot of the non-motor symptoms of Parkinson's, the depression and anxiety."

Doug Tate, 64, was diagnosed with the disease about a year ago after he and his wife noticed some early signs, like a new habit of tapping his foot. Now he has tremors in his right arm and leg. But a week into the study, he noticed that the tremor in his arm vanished temporarily as a result of the cycling sessions. Even better, his overall energy level rose.

"It's the trying that gets you going," he says. "It's one thing to notice the progress on those charts, and it's another to notice the changes yourself. Even my neighbors have noticed it; they said to me, 'Your facial expression is brighter, you're walking more upright, your pace has picked up.'"

Serendipity on a bike

Tate is right; trying harder is the secret behind this low-tech treatment for the ravages of Parkinson's. When biomedical engineer Jay Alberts was an assistant professor at Georgia Tech in 2003, he went on a summer long-distance cycling event with a friend whose wife had the disease. Riding a tandem bike, the couple "had the traditional difficulties that married people do," and Alberts offered to ride with the wife.

"I remember that one time she said, 'It doesn't feel like I have Parkinson's when I'm on the bike,'" recalls Alberts, now at the Cleveland Clinic. Then one night at the camp, Alberts saw a birthday card the woman had written to a cyclist in their group.

In 2009, Alberts published a research paper in the journal Neurorehabilitation and Neural Repair, reporting experiments at the Cleveland Clinic using a stationary tandem bike that increased Parkinson's patients' speed to 30 percent more than their preferred cycling pace. This forced exercise, he and his co-authors wrote, led to "global improvements in motor function."

The paper caught the eye of Sarasota neurologist Dean Sutherland, the medical director for Neuro Challenge. Sutherland knew Alberts' cousin, who lives in Sarasota, and used the connection to invite him to speak at the foundation's annual symposium here.

Sutherland calls this chain of events "serendipitous," the same term Alberts applies to his initial mental link between pedaling and Parkinson's.

"We wound up putting an idea together to obtain a grant to do a pedaling study," Sutherland says. While the motor skills measurements from the study have not yet been crunched, he says, "The people who've done the spinning classes — in or out of the study — are more mobile and have better endurance and balance than other patients."

Because the program is so new, researchers do not yet know why these improvements occur or how long they might last. But after years of having to tell people they have an incurable disease, Sutherland is heartened by the idea of having something helpful to offer them.

"It's fantastic," he says. "It's such a positive thing and it's not even that complicated — ultimately, not even that expensive. It shows them they have more capability than they realize, and that gives them self-confidence and hope."

Alberts, now studying why forced exercise lessens the motor impairments of Parkinson's, says the Sarasota pedaling project can prove that what works in his lab will achieve comparable results in the real world.

"I give the Sudakoff organization a lot of credit for supporting something that's not necessarily what you would typically consider for medical support," he says. "I think what's really important about this study is that the volunteers set an example. Now Sarasota can be this crown jewel with respect to a program that can be emulated across the country."

The smell of cookies

Charlie Campbell, a senior cycling instructor at the Berlin YMCA, has been part of the Parkinson's project since it began as a trial effort in November 2011. Now the Potter Park Y also offers a class, and a video and training manual are in the works for YMCAs nationwide.

"We started out with one time a week, because we were trying to learn what we were doing," Campbell says. "We really wanted to go slow because we were concerned that nobody had ever done this before. If we were going to make mistakes, we said, let's make as few as we possibly can."

Campbell admits he had some doubts when the first Parkinson's patients — many of them older and not used to exercising — had trouble even mounting the stationary bikes. But he and the instructors learned to step up the workouts gradually, lengthening their intervals and speeds so they could begin to feel benefits.

"After they do it for a while, you see consistent results," Campbell says, "like tremors being reduced, and feeling a lot better about their balance. And their hearing, taste and smell come back. If you haven't smelled a chocolate chip cookie in a while, and then you can, it's a big deal."

Christine Ludwig, diagnosed 14 years ago, had not ridden a bicycle for years when she agreed to participate in the study. She has enjoyed watching her classmates' confidence levels rise as they "walk taller and straighter."

Although she has not yet seen her own before-and-after measurements, Ludwig says, "I absolutely believe that the progression of the disease has been slowed in my case. With Parkinson's, even just to hold your own is wonderful, and I was not as good before as I am now."

George Mass, 72, has lived with the disease since 2000. Since his wife signed him up for the study, he has gone from a stationary bike at the Y to being able to ride a recumbent bike in his Sarasota neighborhood. He describes the class as hard work, but worthwhile.

"Well," he says, "you have to earn a lot of things. And that includes your health when you're my age."